The Development and Implementation of a Practitioner in Triage Process for the Emergency Department at Intermountain Medical Center

The number of people visiting the emergency department (ED) has trended upwards over the last 20 years. Over utilization of the ED results in congestion and over crowding. The inappropriate use of the ED by lower acuity patients has created a financial burden and pulled resources from critical patients. Emergency departments have been designed to take care of emergent issues, yet they have become a safety net for all people, often times functioning as a primary care office. The purpose of this project was to develop a Practitioner in Triage (PIT) process to address the issue of over utilization and overcrowding to improve patient flow and hospital efficiency in the ED at Intermountain Medical Center (IMC). The objectives of my project included: (1) the development of a PIT process, (2) the dissemination of this process to the Utah Emergency Physicians and the ED administrators at IMC, and (3) the implementation of this process for use in the ED at IMC. My first objective was met as I researched current PIT staffing models to develop an appropriate staffing model for IMC. My content experts and project chair reviewed and evaluated this process prior to presenting it to the IMC Medical Director and IMC ED Director. My second and third objectives were met by disseminating the process to the appropriate parties and implementing the process in the ED. Implementation occurred after being assigned staff to help put the process into practice. As a group we worked together to successfully implement this process. Variations of a PIT process have been utilized throughout the country. They have been used during high-patient-flow hours to help discharge low acuity patients without tying up a bed, decreasing the length of stay of all patients, and decreasing the number of patients who leave without treatment. Having patients be seen in triage has proven to expand the capacity of the department and resulted in positive patient outcomes and a positive financial impact. Advanced Practice Clinicians (APC) have been utilized in this process and have been found to be cost effective while safely caring for patients. Following a thorough review of the literature and examination of the current staffing model in the ED at IMC, a process was developed and implemented to guide patient flow during busy hours as follows: patients are seen by a physician in triage; lower acuity patients are seen, treated and discharged without occupying a bed in the ED; medium acuity patients are seen by an MD, orders are initiated and the patients are then placed in a room when available. Evaluation of this process, including a formal statistical analysis, will need to be completed in the future to determine if this process has accomplished its goals. Currently this process utilizes an MD, with hopes that in the future this process will be staffed with APC. Ensuring this process is cost effective, while providing high quality care, will need to be evaluated following a trial period, but will not be a part of this project due to time constraints.